Public health approach to prevent cervical cancer in HIV-infected women in Kenya : issues to consider in the design of prevention programs

Women living with HIV in Africa are at increased risk to be co-infected with Human Papilloma Virus (HPV), persistent high risk (HR) HPV infection and bacterial vaginosis (BV), which compounds HPV persistence, thereby increasing the risk for cervical dysplasia. New guidance from WHO in 2014 advocating for a "screen and treat" approach in resource poor settings is becoming a more widely recommended screening tool for cervical cancer prevention programs in such contexts. This review article summarizes the risk factors to be considered when designing a primary and secondary cervical prevention program in a post-vaccination era for HIV-infected women in Kenya. This review article is based on our prior research on the epidemiology of pHR/HR-HPV genotypes in HIV-infected women and CIN 2+ in Kenya and other sub-Saharan contexts. In order to contextualize the findings, a literature search was carried out in March 2017 by means of four electronic databases: PUBMED, EMBASE, SCOPUS, and PROQUEST. Risk factors for potential (pHR)/HR HPV acquisition, including CD4 count, HAART initiation, Female Sex Worker status (FSW) and BV need to be considered. Furthermore, there may be risk factors for abnormal cytology, including FSW status, multiple potential (p) HR/HR HPV genotypes, which may require that HIV-infected women be subjected to screening at more frequent intervals than the three year recommended by the WHO. The quadruple synergistic interaction between HIV, HPV and BV and its related cervicitis may need to be reflected within a larger prevention framework at the community level. The opportunities brought forth by the roll out of HAART could lead to task shifting of HIV-HPV-BV care to nurses, which may increase access in poorly-served areas

Distribution of human papillomaviruses and bacterial vaginosis in HIV positive women with abnormal cytology in Mombasa, Kenya

Background: HPV is the major etiological factor in the causal pathway for cervical cancer, which is the leading cancer among women in sub-Saharan Africa. HIV is associated with a higher prevalence and a broader range of high-risk HPV genotypes. Studies have shown a positive association between Bacterial vaginosis (BV) and HPV and HIV. Also, in African women, BV was found to be significantly associated with vaginal inflammation. The high prevalence of BV, HIV and HPV infections in the African continent makes elucidation of the interactions with one another of utmost public health interest. The aims of the current study are to examine the frequency of HPV genotypes and BV as well as their respective risk factors within an HIV infected population with abnormal cytology in the resource-constrained setting of Mombasa, Kenya and, secondly, highlight issues to consider for triple co-infection clinical management. Method: Cross-sectional analysis with a sample drawn from an ongoing cohort study. All consenting, non-pregnant HIV infected women, between 18 and 50 years of age, without a history of cervical cancer or hysterectomy, between November 2005 and April 2006 were screened for HR HPV DNA in Mombasa, Kenya. 1 out of 4 HIV positive women fulfilled the criteria by having SIL (24.9 %). 600 HIV infected women were tested to reach a cohort of 74 HIV women with abnormal cytology. To assess which factors were associated with HR HPV, crude statistical analysis was performed through logistic regression. Results: Bacterial vaginosis (BV) was found in 46 women out of 74 (62.2 %). Cervicitis was diagnosed in 15 % of women (n = 11), of which 8 had BV. The most prevalent HPV genotypes were HPV 16 (33.8), HPV 53 (24.3) and HPV 18 (17.6 %), while 65 % of the participants had multiple genotype infection. Statistically significant associations between CD4 counts = 350 mu l and HPV 16 adjusted for age (OR = 2.9; 95 % CI: 1.0-8.3; p = 0.05). A borderline statistically significant association was observed between BV and HPV58 (crude OR = 4.1, 95 % CI: 0.8-21.0; p = 0.07). Conclusion: The most prevalent HPV genotypes observed were HPV 16, HPV 53, and HPV 18, which have a combined prevalence of 76 %. Our results show that a triage based on CD4 count should start at CD4 count >= 350 mu l as our study suggests that HPV 16 are more prevalent when women are moderately immunosuppressed. Given the high prevalence of HPV 53 in a HIV infected population with abnormal cytology, its cervical carcinoma genesis potential as a stand-alone genotype and as well as its synergism with multiple infections should be investigated. The new WHO guideline in resource-poor settings to rescreen women for HPV within ten years may be more effective if BV and cervicitis management become a major component for HIV-HPV management

Revisiting zoonotic human African trypanosomiasis control in Uganda

Objectives: Human migration and concomitant HIV infections are likely to bring about major changes in the epidemiology of zoonotic parasitic infections. Human African trypanosomiasis (HAT) control is particularly fraught with intricacies. The primarily zoonotic form, T.b. rhodesiense, and the non-zoonotic T.b. gambiense coexist in Northern Uganda, leading to a potential geographic and genetic overlap of the two foci. This region also has the highest HIV prevalence in Uganda plus poor food security. We examine the bottlenecks facing the control program in a changed political and economic context. Method: We searched the literature in July 2015 using three databases: MEDLINE, Google Scholar, and Web of Science. Findings: Decentralized zoonotic HAT control for animal reservoirs and vectors compromise sustainability of the control programs. Human transmission potential may be underestimated in a region with other endemic diseases and where an HIV-HATepidemic, could merge two strains. Conclusion: Our comprehensive literature review concludes that enhanced collaboration is imperative not only between human and animal health specialists, but also with political science. Multi-sectorial collaborations may need to be nurtured within existing operational national HIV prevention frameworks, with an integrated surveillance framework

A portable OpenCL-based unstructured edge-based Finite Element Navier-Stokes solver on graphics hardware

The rise of GPUs in modern high-performance systems increases the interest in porting portion of codes to such hardware. The current paper aims to explore the performance of a portable state-of-the-art FE solver on GPU accelerators. Performance evaluation is done by comparing with an existing highly-optimized OpenMP version of the solver. Code portability is ensured by writing the program using the OpenCL 1.1 specifications, while performance portability is sought through an optimization step performed at the beginning of the calculations to find out the optimal parameter set for the solver. The results show that the new implementation can be several times faster than the OpenMP version.Preprin

Los eventos biotecnológicos y su impacto en la agricultura

En la presente comunicación se analizan loa avances tecnológicos para la agricultura y como influyen en el desarrollo de la misma.Trabajo galardonado con el Premio "Bolsa de Cereales", versión 1999Academia Nacional de Agronomía y Veterinari

Los eventos biotecnológicos y su impacto en la agricultura

En la presente comunicación se analizan loa avances tecnológicos para la agricultura y como influyen en el desarrollo de la misma.Trabajo galardonado con el Premio "Bolsa de Cereales", versión 1999Academia Nacional de Agronomía y Veterinari

Personal values in mental disorders: an exploratory analysis

AbstractPersonal values have increasingly become central in socio-psychological research. However, the relationships between values and psychopathological variables have been scarcely investigated, with mixed results. This study aimed to explore potential differences in value orientation in a sample of people with psychotic disorders and mood disorders compared to a non-clinical sample using the Schwarz's values framework. A clinical sample of 162 subjects (92 subjects with psychotic disorders and 70 with mood disorders) and a non-clinical sample of 217 subjects completed the self-report measures of affective states (PANAS) and personal values (PVQ). Irrespective of the diagnostic group, the clinical sample showed higher expression of Conservation values (i.e., Tradition, Conformity, Security). Conservation and Self-enhancement values positively correlated with PANAS-positive affectivity in the clinical sample; in the non-clinical sample, Self-enhancement values only correlated with PANAS-positive affectivity. The expression of Conservation values in individuals with a mental disorder could reflect an orientation toward Conformity underlying fundamental affiliative goals. The complex relationship between personal values and clinical constructs should be further investigated, with important theoretical and clinical implications in mental health

Effects of malaria/helminthic coinfections on cervical cancer progression among sub Saharan African women on highly active antiretroviral therapy : a scoping review

In Africa, the HIV prevalence in rural areas has begun to reach levels estimated within urban settings, where women are also more at risk for both malaria and intestinal parasitic infections. The objective of this review is to assess whether concomitant infections with malaria and/or helminthic diseases have an impact on cervical disease progression in women on HAART. This scoping review was conducted in August 2018. To conduct this scoping review, we searched the relevant studies in electronic databases such as PUBMED, Global Health, EMBASE, CINAHL and SCOPUS published in the year between 1960 and 2018 using the following search terms HAART AND malaria OR Helminth and Female OR women. Eight studies qualified for this review. The literature underscores the need for women on HAART with multiple co-infections to use adjuncts to retain immune recovery and undetectable HIV viral load, to reduce risk of cervical disease progression. A trend for higher risk of CIN3+ in HIV+ women reporting recent malarial infection was observed in one study. Given the public health impact of synergistic interactions between malaria and helminthic infections in HIV/HPV co-infected women on HAART, it is urgent that these interactions are elucidated

Lagrangian FE methods for coupled problems in fluid mechanics

This work aims at developing formulations and algorithms where maximum advantage of using Lagrangian finite element fluid formulations can be taken. In particular we concentrate our attention at fluid-structure interaction and thermally coupled applications, most of which originate from practical “real-life” problems. Two fundamental options are investigated - coupling two Lagrangian formulations (e.g. Lagrangian fluid and Lagrangian structure) and coupling the Lagrangian and Eulerian fluid formulations. In the first part of this work the basic concepts of the Lagrangian fluids, the so-called Particle Finite Element Method (PFEM) [1], [2] are presented. These include nodal variable storage, mesh re-construction using Delaunay triangulation/tetrahedralization and alpha shape-based method for identification of the computational domain boundaries. This shall serve as a general basis for all the further developments of this work.Postprint (published version

Mejora genética y parámetros de calidad del silaje de sorgo (Sorghum bicolor L. Moench) en comparación con el ensilaje de maíz (Zea mays L.)

The aim of this review was to report studies on genetic improvement of sorghum (Sorghum bicolor L. Moench), intended for obtaining genotypes with better forage characteristics for silage production. Among the forages destined to silage production, the sorghum constitutes a good alternative, with production superior to 20 t ha-1 of dry biomass. The main advantage of using sorghum is the possibility of producing higher biomass volume and better quality silage, with digestible fibers of great animal consumption and performance, in areas where cultivation restrictions for maize and others forages are risky and/or impossible. One of the limitations of using sorghum on animal nutrition is the tannin concentration in the grain, relating negatively with dry mass digestibility. By means of genetic improvement, such situation, through the knowledge of genetic inheritance of this characteristic, enabled 95% of the national sorghum to be devoid from tannin in the grains. As for the bromatological composition of silage, the sorghum presents fiber levels on neutral detergent varying from 52% to 56% against 45% to 64% in maize, in acid detergent from 32% to 35% against 28% to 35% in maize, and dry matter digestibility in vitro from 52% to 56% against 54% to 78% in maize, evidencing strong similarities regarding these parameters. The genetic improvement has made the sorghum cultivation an alternative to the maize replacement for animal nutrition.O objetivo desta revisão foi relatar trabalhos com melhoramento genético de sorgo (Sorghum bicolor L. Moench), destinados a obtenção de genótipos com melhores características forrageiras para produção de silagem. Entre as forrageiras destinadas a produção de silagens o sorgo constitui-se numa boa alternativa com produtividade superior a 20 t ha-1 de biomassa seca. O grande destaque na utilização do sorgo é a possibilidade de se produzir maior volume de biomassa e uma silagem de melhor qualidade com fibras digestíveis de elevado consumo e desempenho animal, em áreas de restrição ao cultivo do milho e/ou outras forrageiras se torna impossível ou de risco. Um dos limitadores do uso do sorgo na nutrição animal é a concentração de taninos condensados no grão por relacionar-se negativamente com a digestibilidade da matéria seca. Por meio do melhoramento tal situação, via conhecimento das heranças genéticas desta característica, possibilitou atualmente em 95% do sorgo nacional não possuir tanino nos grãos. Quanto à composição bromatológica de silagem, o sorgo apresenta teores de fibra em detergente neutro variando 52% a 56% contra 45% a 64% em milho, fibra em detergente ácido de 32% a 35% contra 28% a 35% em milho e digestibilidade in vitro da matéria seca de 52% a 56% contra 54% a 78% em milho, evidenciando fortes semelhanças quanto a estes parâmetros. O melhoramento genético tornou a cultura do sorgo forrajeiro em uma opção alternativa a substituição do milho na alimentação animal.El objetivo de esta revisión fue reportar artículos a respecto de la mejora genética del sorgo (Sorghum bicolor L. Moench) con el fin de la obtención de genotipos con las mejores características de forraje para ensilado. Entre las forrajee destinados a la producción de ensilaje el sorgo constituye una buena alternativa con productividad superior a 20 t ha-1 de biomasa seca. Lo más destacado en el uso de sorgo es la posibilidad de producir mayor volumen de biomasa y ensilaje de mejor calidad, con fibras digeribles de alto consumo y rendimiento animal en las zonas de restricción de cultivo de maíz y/o otros forrajes se convierte en imposible o de riesgo. Uno de los limitadores del sorgo en la alimentación animal es la concentración de taninos condensados en el grano por se relacionaren negativamente con la digestibilidad de la materia seca. Por medio del mejoramiento esta situación, a través del conocimiento de la herencia genética de esta característica, permitió actualmente en 95% del sorgo nacional no tener el tanino en el grano. Cuanto a la composición bromatológica del ensilaje, el sorgo presenta fibra detergente neutro que van de 52% a 56% contra 45% a 64% en el maíz, fibra detergente ácida de 32% a 35% contra 28% a 35% en el maíz y digestibilidad in vitro de la materia seca de 52% a 56% contra 54% a 78% en el maíz, que muestran fuertes similitudes en estos parámetros. El mejoramiento genético tornó la cultura del sorgo forrajero en una opción alternativa para reemplazar el maíz en la alimentación animal